§ 10.202 Controversion by employing

agency.

(a) The employing agency may, on the basis of the information submitted by the employee, or secured on investigation, controvert a claim and terminate an employee's pay only if:

(1) The disability is a result of an occupational disease or illness; or

(2) The employee falls within the exclusions of 5 U.S.C. 8101(1)(B) or (E);

or

(3) The employee is neither a citizen nor resident of the United States or Canada (i.e., a foreign national employed outside of the United States or Canada); or

(4) The injury occurred off the employing agency's premises and the employee was not engaged in official "off premise" duties; or

(5) The injury was caused by the employee's willful misconduct, the employee intended to bring about the injury or death on himself or herself or another person or the employee's intoxication was the proximate cause of the injury; or

(6) The injury was not reported on Form CA-1, within 30 days following the injury; or

(7) Work stoppage first occurred six months or more following the injury;

or

(8) The employee initially reports the injury after his or her employment has terminated; or

(9) The employee is enrolled in the Civil Air Patrol, Peace Corps, Job Corps, Youth Conservation Corps, Work Study Programs, or other similar groups.

(b) In all other cases, the employing agency may controvert an employee's right to continuation of pay, however, such employee's regular pay shall not be interrupted during the 45 day period unless the controversion is sustained by the Office and until the employing Agency is so notified.

§ 10.203 Manner of controversion.

An employing agency may controvert a claim for purposes of this subpart by completing the indicated portion on Form CA-1, Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation, and submitting detailed in

formation in support of the controver sion to the Office.

§ 10.204 Termination of continuation of pay.

(a) Where pay is continued after an employee stops work due to a disabling traumatic injury, such pay shall not be terminated until:

(1) The agency receives medical information from the attending physician to the effect that the employee is no longer disabled; or

(2) The agency receives notification from the Office that pay should be terminated; or

(3) The expiration of 45 days.

(b) The 45 days during which pay may be continued pursuant to this subpart are calendar days and if the employee has stopped work due to the disabling effects of the injury, the period starts at the beginning of the first full day or first full shift during which the disability begins provided such disability began within six months of the occurrence of the injury. The agency will keep the employee in a pay status for any fraction of a day or shift on which the disability begins with no "charge" to the 45 day period. If the employee stops work for only a portion of a day or shift (other than the day or shift when disability begins), such day or shift will be considered as one calendar day. If the employee is not immediately disabled due to the injury, the 45 days will begin on the first full day or the first full shift when disability begins.

(c) Where pay is continued at a rate subsequently determined by the Office to be incorrect, the Office shall notify the agency of the correct pay rate and the agency will make the necessary adjustment.

§ 10.205 Regular pay defined.

(a) For a regular full-time or parttime worker in the regular work force of the agency who works the same number of hours per week, the weekly pay rate shall be equal to the number of hours regularly worked each week times the hourly pay rate on the date of injury, exclusive of overtime.

(b) For a regular part-time worker in the regular work force of the agency who does not work the same number

toff hours per week the weekly pay rate hall be the average weekly earnings or the one year period prior to the Cate of injury, exclusive of overtime.

of

(c) For an irregular WAE, intermitntingent, etc., worker who is not a part of ue the agency's regular full or part-time work force, the weekly pay rate shall De

the average of the employee's ves weekly earnings during the one year enorior to the injury, but the average

annual earnings may not be less than 150 times the average daily wage rearned within one year prior to the ydate of injury. (The daily wage rate shall be the hourly rate times 8.) Predan mium, night or shift differential, Sunday or holiday pay, or other extra pay should be included in all instances; however, overtime pay must not in any instance (i.e., either regular or irregular employment) be made a part of the continuation of pay rate.

d

§ 10.206 Agency accounting and reporting of continuation of pay.

(a) Pending development of a system the within the Office for directly capturining and tabulating data on continuing payments to employees under 5 U.S.C. 8118, each agency and instrumentality of the United States having an employee who was in a continuation of pay status during the calendar quarter shall submit a report to the Office within 30 days after the end of each quarter (address: Director, Office of Workers' Compensation Programs, U.S. Department of Labor, Washington, D.C. 20211).

(b) Quarterly reports are to include data on all continuation of pay cases paid in the quarter for only those employees who have returned to work or exceeded the 45-day period by the last pay date of the reporting agency or instrumentality during the quarter (employees who have not returned to work or exceeded the 45-day period by the last pay date of the quarter are to be reported in the following quarter).

(c) Reported summary data for employees returning to work during the quarter is to include:

(1) Total number of employees provided such continuation of pay.

(2) Total number of workdays or shifts (full workdays) for which these employees were paid during the quar

ter (and the earlier quarter if return to work did not occur during such earlier quarter).

(3) Total amount paid to all employees during the quarter (and the earlier quarter if return to work did not occur during such earlier quarter).

OFFICIAL SUPERIOR'S AND
BENEFICIARIES' RESPONSIBILITIES

§ 10.207 Official superior's responsibility in continuation of pay case.

(a) Upon receiving notice that an employee has suffered an employment related traumatic injury an official superior shall:

(1) Promptly authorize medical care in accordance with Subpart E of this part;

(2) Provide the employee with Form CA-1 for reporting the injury and upon receipt of the completed form, return to the employee the "Receipt of Notice of Injury.";

(3) Advise the employee of the right to elect continuation of regular pay or use annual or sick leave, if the injury is disabling;

(4) Inform the employee whether continuation of pay will be controverted, and if so, whether pay will be terminated, and the basis for such action;

(5) Promptly submit Form CA-1 fully completed by both employee and official superior together with all other pertinent information and documents to the Office within two working days following the official superior's receipt of such completed form from the employee.

(6) If the official superior controverts the claim (whether or not pay is terminated), explanation for the controversion will be submitted to the OWCP on the official superior's portion of Form CA-1 and/or by separate narrative report.

(7) In addition, such official superior shall report to the Office any injury resulting in probable disability or death in accordance with this part, and thereafter make any additional reports as the Office may require.

(b) In the case of a traumatic injury for which the continuation of pay may be appropriate, the injured employee's official superior shall to the best of his or her ability inform such employee of

the advantages and disadvantages of the continuation of pay provisions of the Act. Special attention shall be drawn to the fact that continued pay is subject to taxes and all other regular payroll deductions as well as to the fact that an employee who chooses not to elect continuation of pay may be without income for an undetermined period of time subsequent to the onset of his or her disability.

§ 10.208 Recurrence of disability.

(a) Should an employee suffer a recurrence of disability, and again stop work and the initial claim has been approved by the Office, the official superior shall promptly complete Form CA-2a. The employee shall advise the official superior whether he or she wishes to continue to receive regular pay or charge the absence to sick or annual leave.

(b) If the employee so elects, the official superior shall again continue regular pay, providing the 45 calendar days were not all "used" during the initial period of disability. This is applicable, however, only during a six month period beginning from the date the employee first returned to work following the initial disability. If a recurrence happens after the six months have expired, the employing agency should not continue regular pay, although some of the 45 days may remain "unused". In such instances, the employee is entitled only to compensation payable by the Office.

(c) If the 45 day entitlement period has been exhausted, or six months have expired since the employee first returned to work, the employing agency is not required to continue regular pay. The Office shall be responsible for initiating payment of compensation. In such instance, the employee shall file claim for any wage loss on the appropriate Form CA-7 or CA-8.

(d) If the recurrence happens less than six months following the most recent prior medical treatment received by the employee, the official superior shall authorize required medical care by use of Form CA-16. If the recurrence happens more than six months after the most recent prior medical care, authorization for further

(a) When an employee sustains a traumatic, disabling injury in the performance of duty, the employee or someone acting on his or her behalf must give a written report on Form CA-1 to such employee's official superior within two working days following the injury. It must be shown on the form whether the employee wishes to receive sick or annual leave [see § 10.210(a)] or request continuation of regular pay for the period of disability.

(b) Upon reporting the injury, the employee will be authorized to obtain medical treatment if required. If treatment is obtained, the employee must inquire from the treating physician the earliest date that the employee is able to return to work.

(c) A "Duty Status Report," Form CA-17 will be used to obtain interim medical reports concerning the employee's duty status. If during the 45 day period the treating physician indicates the employee is able to return to work and the employee refuses to do so, the continued absence from work may result in an overpayment. The period of absence from the job which resulted in the overpayment will be determined by the Office in the course of adjudication of the claim. The official superior and the employee will be notified of the period of disability which is approved by the Office and the official superior may then require the employee to resolve any overpayment.

(d) If medical evidence shows disability is expected to continue beyond 45 days and compensation is desired after expiration of the period, Form CA-7, must be completed and filed with the appropriate OWCP district office not more than 5 working days after the termination of the 45 days.

(e) The provisions of Subpart D of this part relating to the buy-back of leave and to collection of overpayments are applicable as appropriate to the provisions of this subpart.

§ 10.210 Election of annual or sick leave.

(a) In any case, an employee may use annual or sick leave to his credit at the time such employee's disability begins, but such employee's compensation for disability does not begin, and the time periods specified by 5 U.S.C. 8117 do not begin to run, until the termination of continuation of pay (see § 10.204) or until the use of annual or sick leave ends.

(b) If a claim for the continuation of pay is denied by the Secretary subsequent to the making of such payments, such payments shall, at the option of the employee, be charged to sick or annual leave or shall be deemed overpayments of pay within the meaning of Section 5584 of Title 5, United States Code.

Subpart D-Payment of Compensation

COMPENSATION RATES

§ 10.300 Maximum and minimum compensation.

(a) Disability. Compensation for disability may not exceed 75 percent of the monthly pay of the highest step of grade 15 of the General Schedule. For total disability, it may not be less than 75 percent of the monthly pay of the first step of grade 2 of the General Schedule or actual pay, whichever is less.

(b) Death. Compensation for death is computed on a minimum pay equal to the first step of grade 2 of the General Schedule. The total compensation may not exceed the employee's pay or 75 percent of the monthly pay of the highest step of grade 15 of the General Schedule, except that compensation is allowed to exceed the employee's monthly pay if such excess is created by authorized cost of living increases. § 10.301 Temporary total disability rate.

(a) Compensation based on loss of wages is payable, subject to the provisions of 5 U.S.C. 8117, after the 45th day in traumatic injuries or from the beginning of pay loss in all other types of injuries.

(b) When an injured employee loses pay due to temporary total disability

resulting from an injury, compensation is payable at the rate of 66% percent of the pay rate established for compensation purposes. The compensation rate is increased to 75 percent when there are one or more dependents. Dependents include a wife or husband; an unmarried child under 18 years of age or if over 18, incapable of self-support, or a student (until reaching 23 years of age or completing four years of school beyond the high school level); or a wholly dependent parent. Compensation begins when the employee starts to lose pay if the injury causes permanent disability or if there is pay loss for more than 14 days, otherwise compensation begins on the fourth day after pay stops. Compensation may not be paid while an injured employee receives pay for leave or is otherwise in a continuation of pay status. The employee has the right to elect whether to receive pay for leave or to receive compensation.

§ 10.302 Permanent total disability rate.

When the injury causes permanent total disability, an injured employee is entitled to compensation until death unless the employee is medically or vocationally rehabilitated. Some, al

though not all, of the examples of permanent total disability are loss, or loss of use, of both arms; or both feet; or both legs; or both eyes or the sight thereof. Compensation for total disability equals 66% percent of the employee's pay, and 75 percent when there is a dependent [see § 10.301(b)]. The employee may receive additional compensation, not to exceed $500 per month, when the services of a full time attendant are needed because of the disability.

§ 10.303 Partial disability rate.

(a) Loss of wage-earning capacity. An injured employee may receive compensation computed on loss of wageearning capacity when unable to return to usual employment because of partial disability as a result of the injury. The compensation will equal 66 percent of the employee's loss. It will equal 75 percent of the loss when there is a dependent [see § 10.301(b)]. The compensation will be paid so long

as there is a loss of wage-earning capacity.

(b) Scheduled awards. Compensation is provided for specified periods of time for the permanent loss or loss of use, of each of certain members, organs, and functions of the body. Compensation for proportionate periods of time is payable for partial loss, or loss of use of each member, organ, or function. The compensation for scheduled awards will equal 66% percent of the employee's pay, and 75 percent of the pay when there is a dependent. Proper and equitable compensation, not to exceed $3,500 may be paid for serious disfigurement of the face, head, or neck, if of a character likely to handicap a person in securing or maintaining employment. Compensation for loss of wage-earning capacity may be paid after the schedule expires.

10.304 Schedule compensation rate.

(a) Pursuant to 5 U.S.C. 8107, com pensation is provided for the permanent partial or permanent total loss of use of specified members of the body and internal and external organs as well as for serious disfigurement of the face, head, or neck. A new section, 5 U.S.C. 8107(c)(22) added by Pub. L. 93-416, 88 Stat. 1145, provides that in addition to the member and organs specifically enumerated in the compensation schedule the Secretary may provide for the payment and schedule compensation not to exceed 312 weeks of compensation for such internal and external organs as is deemed appropriate. Pursuant to authority contained in 5 U.S.C. 8107(c)(22) certain specified internal and external organs are added to the compensation schedule as follows:

may, in the future, result in the further extension of the compensation schedule. Such further extensions shall have retroactive application back to the effective date of this section if such retroactive application is deemed appropriate by the Director.

(c) Schedule compensation rates shall be determined as provided in § 10.302 and § 10.303 of this part. Such amounts as are determined appropriate pursuant to the Act and this part

are:

(1) Payable regardless of whether the cause of the impairment originates in a part of the body other than the impaired member or organ;

(2) Payable regardless of whether the disability also involves another impairment of the body; and

(3) In addition to compensation for temporary total or temporary partial disability.

§ 10.305 Death benefit rates, conditions of eligibility.

(a) When there are no children entitled to compensation the employee's widow or widower may receive compensation equal to 50 percent of the employee's pay until death or remarriage. Upon remarriage, a widow or widower will be paid a lump sum equal to 24 times the monthly compensation being paid on his or her own behalf, except that if such remarriage occurs on or after the age of 60, the lump sum payment shall not be made and compensation shall continue until the beneficiary's death.

(b) When there is a child entitled to compensation, the compensation for the widow or widower will equal 45 percent of the employee's pay plus 15 percent for each child, but shall not exceed 75 percent of the employee's pay. A child is entitled to compensation until he or she dies, marries, or reaches 18 years of age, or if over 18 and incapable of self-support, until he or she becomes capable of self-support. If an unmarried child is a student when reaching 18 years of age, compensation may be continued for as long as the child remains a student or until he or she marries. It may not, however, be continued beyond the end of the semester or enrollment period after the child reaches 23 years of age